肝癌肝移植Milan标准的临床意义探讨

目的探讨肝癌肝移植Milan标准的临床应用价值和注意事项。方法回顾性分析2001年12月至2005年11月术前cT检查符合Milan标准的125例肝细胞癌行肝移植患者的临床资料,对比影像学与病理学检查结果的差别及其对患者生存时间的影响。结果125例患者中,切除肝脏病理检查证实符合Milan标准者97例,超出Milan标准者26例,2例未发现癌灶最终诊断为结节状肝硬化,准确率为77．6％。影像学与病理学符合Milan标准的肝移植患者的1、2、3、4和5年生存率分别为92．0％和92．8％、87．2％和90．7％、86．4％和89．7％、86．4％和89．7％、86．4％和89．7％,两组间生存率无明显差别（P〉0．05）。病理学上超出Milan标准的患者1、2、3、4和5年生存率分别为73．0％、65．4％、61．5％、61,5％和61．5％,与病理学符合及影像学检查符合组间均存在明显差异（P〈0．05）。结论术前螺旋CT诊断符合Milan标准的肝细胞癌患者肝移植术后生存良好,但应进一步提高诸如门静脉主要分支癌栓、淋巴结转移等导致病期误判因素的诊断水平。

Clinical study of Milan criteria for liver transplantation

OBJECTIVE: To investigate the value and deficiency of Milan criteria for liver transplantation in patients with hepatocellular carcinoma (HCC). METHODS: Between December 2001 and November 2005, 125 patients underwent orthotopic liver transplantation ( OLT), who measured up Milan criteria with preoperation computerized tomography (CT) scaning. The results of pre-transplant multidetector CT scan and post-transplant pathology were retrospectively analyzed, and survival rates were compared. RESULTS: Pathology examination certificated that 97 cases met Milan criteria (77.6%), 26 cases exceeded Milan criteria,and the other 2 cases were diagnosed as nodular cirrhosis. The 1-,2-,3-,4- and 5-year survival rates for those met pre-transplant multidetector CT scanning pre-transplant met Milan criteria vs. those met post-transplant pathology post-transplant criteria were 92.0% vs. 92.8%, 87.2% vs. 90.7%, 86.4% vs. 89.7%, 86.4% vs. 89.7%, and 86.4% vs. 89.7%, respectively. There was no statistic significant difference (P > 0.05). The 1-,2-,3-,4- and 5-year survival rates were 73.0%, 65.4%, 61.5%, 61.5% and 61.5%, for those pathology exceed Milan criteria respectively. The difference between this group and each of the above two were statistically significant (P < 0.05). CONCLUSIONS: The prognosis of OLT for HCC is good for those met Milan criteria by pre-transplant multidetector CT. Factors leading to poor prognosis such as portal vein tumor thrombi and lymphatic metastasis should be accurately evaluated avoiding for misjudgement.